Hyponatremia

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Author:
bigfootedbertha
ID:
84373
Filename:
Hyponatremia
Updated:
2011-05-07 13:32:57
Tags:
nephrology
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Description:
For my upcoming nephrology exam
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  1. What is hyponatremia?
    Na <135
  2. What is severe hyponatremia?
    Na < 120-125
  3. What are sx of hyponatremia, and at what Na level do you start to see them?
    • Confusion, N/V, seizure, obtundation
    • See at <120
  4. What labs do you order for someone who is hyponatremic?
    • Serum osm
    • Urine osm
    • Urine Na
    • Urine Cr
  5. What is the most common form of hyponatremia?
    Hypotonic hyponatremia
  6. What is hypotonic hyponatremia?
    • Excess of water relative to Na
    • serum osm <280
  7. What is isotonic hyponatremia?
    • Rare, lab artifact, possible from hyperproteinemia and HL
    • serum Osm is 280-285
  8. What is hypertonic hyponatremia?
    • Result of another osmole like glucose or mannitol drawing water extracellularly?
    • serum OSM >295
  9. How do you tx acute sxmatic hyponatremia?
    • Correct at rate of 2mEq/L/h for the first 2-3 hours until sx resolve using hypertonic saline (3%)
    • Do not correct more than 10-12 mEq in 24 hours
  10. How do you tx acute asx hyponatremia?
    • Correct at a rate of 0.5 mEg/L/hr
    • Do not correct more than 10-12 mEq in 24 hours
  11. What happens if you correct hyponatremia too fast?
    Central pontine myelinolysis
  12. How do you tx hypovolemic hyponatremia?
    Replete volume with NSS
  13. What causes euvolemic hyponatremia?
    • SIADH
    • hypothyroidism
    • Adrenal insufficiency
    • Primary polydipsia
  14. What causes hypervolemic hyponatremia?
    • Cirrhosis
    • CHF
    • Renal failure
  15. What causes hypovolemic hyponatremia?
    • Renal loss (ie diuretics)
    • Mineralcorticoid deficiency
    • Extra-renal loss
  16. How do you tx euvolemic hyponatremia caused by SIADH?
    • Free water restriction, tx underlying cause, possible Tolvaptan but consult nephrology first
    • DO NOT USE NSS
  17. How do you tx hypervolemic hyponatremia?
    • restrict free water
    • Lasix in CHF
    • colloid infusions in cirrhotics

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